Evidence-Based Tinnitus Management – Doug Beck, AuD – #02

Doug Beck, AuD
There are many people who are incredibly highly stressed, unable to sleep, unable to work, unable to concentrate unable to hear because their tinnitus is so called the number one management technique for tinnitus with or without hearing loss is actually hearing it. And that may strike people as weird if they don’t have hearing loss.

Ben Thompson, AuD
Welcome to episode number two of the pure tinnitus podcast. Today, we are here with a guest coming all the way from Texas in the United States. This is Doug back. And for anyone who knows about audiology, who knows about hearing loss science, you’ve probably heard of Doug back before we’re grateful to have him on with pure tinnitus. So let me introduce Doug for any listener out there. So Doug, is the current vice president of academic Sciences at oticon. He is a senior editor of clinical research at hearing review, and previous adjunct clinical professor at the State University of New York in Buffalo. Hang tight with us guys watch this whole episode because you’re going to learn a lot about how to use research how to use the understanding of scientific knowledge for your tinnitus and some simple things you can do that’s based on research. So Doug has an extensive list of publications in audiology and medical research. He previously worked at the house ear Institute in California, audiology, online.com, and the Arizona School of Health Sciences and most recently with a hearing device manufacturer oticon. Doug is also a father, guitarist, drummer and Doctor of Audiology. My name is Ben Thompson. I’m the host here with pure tinnitus. I first met Doug about five years ago, when he presented to our presentation on the best practices for tinnitus management at a conference in California, where he explained how evidence based research can build the audiologists confidence in tinnitus treatment protocols. And with all that we welcome Doug here. And Doug, so great to have you here. Can you please tell us how this whole journey started for you?

Dr. Thompson interviews Dr. Beck.

Doug Beck, AuD
Well, first of all, thank you for inviting me, Ben, it’s a pleasure to work with you. Wow, when I got out of the air force, which was over 40 years ago, I felt I was too old to go to medical school. I was attending, I was a math and science major State University of New York at Buffalo. I was the first person in my family that ever went to college. And I just thought at that point, I was too old to pursue medicine. And so I was looking for something in science and something that was that was kind of cool and interesting. And I was just the dumbest of luck. I had a brilliant counselor looked at my math and science ability. And she said, you know, we have one of the most famous audiologists in the world here, Dr. JACK Katz. And you should go talk to him. And anyway, so I went and I spoke with Dr. Katz. And, as you know, and as anybody in audiology knows, Dr. Katz is a legend. He pretty much was one of the one of the primary pioneers in auditory processing disorders. And in other phenomena that’s auditory based, and I had the good fortune to get my bachelor’s degree with him. And then I got my master’s with him. And then I went to the healthcare Institute in Los Angeles, that was the early 80s. Before cochlear implants were FDA approved. Most people think cochlear implants started in 1986. Well, that’s when the FDA approved them. But the first ones were done in 1959. And then at three we’re done at the healthcare Institute in Los Angeles at 61. So I worked with Bill house in the operating room and I and it was absolutely the most stellar education I could have. I learned so much more by being at the house your institute for three or four or five years than I learned in graduate school. So I was doing interoperative cranial nerve monitoring during skull base surgery. We were doing a ton of cochlear implant research. And it was just you know, dumb luck really, I had no plan to do this. It’s just I was very fortunate.

Ben Thompson, AuD
One step after the other, I suppose. Now taking a deep dive into the neurology into our neurological system, the auditory hearing, and other parts of our brain and how that all interacts. So how do you think that that foundation has developed your understanding of tinnitus because most of our listeners have some degree of ringing in the ears and they may have some degree of hearing damage or hearing loss? So I’m wondering for you, what advice do you have for our listeners who have bothersome tinnitus and mild high pitch hearing loss?

Doug Beck, AuD
Okay, so there’s a couple of things if we unwrap that, you know, first of all hearing, we should just define that as perceiving sound. Listening is attending to sound and listening is making sense of sound listening is untangling the sound to have to apply meaning to sound. And when you think about like right now you hear me knocking Pretty benign. That’s that’s hearing. But when we speak, and humans are unique in this we can attribute meaning to sound. You might say, well, dogs communicate. You might say cats communicate. Yeah, they do but not very well, you know, a dog barking at something that is scared of or something that wants to scare. You know, that means I’m scared, it doesn’t have a lot of meaning you and I, on the other hand can talk about science, we can talk about 150 years in the past, we can talk about 20,000 years in the future, we can talk about flight, we can talk about history, we can talk about religion, we can talk about politics. animals can’t do that. So the human brain is what separates us from all other beings. And you were you and I were speaking before the recording about can simple words like word recognition score, really tell you a lot? And the answer is they can tell you a little bit but but every single sound that you hear your brain has to process. But with very, very simple sounds like say the word went say the word she, when you have simple sounds like that it doesn’t take much grain at all. Here’s an example. You could say to a parent 300 times I love you. I love you. I love you. And pretty soon the parent will say I love you, and the parent does not have any idea what you’re talking about. So, you and I have to process deeper than monosyllabic words to make sense. So hearing is perceiving sound listening is making sense of sound in you and I in background noise can selectively attend to who we want to attend to. So that’s a little bit very, very minimalist approach to neuroscience and audition. And when you talk about tinnitus now, here are the numbers. There’s 325 million people in the USA, there’s probably about 50 million people who if you ask them to bring in their ears would say yes, there’s 37 to 38 million people in the USA who have hearing loss on an audiogram. So more people would say they have hearing loss and would say they have I’m sorry, I would say they have tinnitus, and we’ll say they have hearing loss. But if you were to prioritize people with tinnitus, not just that I hear an occasional ring, but it’s there all the time. There’s probably 16 to 20 million in the USA, but the people who are tinnitus patients are the ones who are bothered by tinnitus, because it’s unrelenting. These are people who seek help for their tinnitus because it is so bad that it causes all sorts of difficulty the difficulty cause you could interrupt their hearing interrupt their sleep interrupt their ability to concentrate, which Tyler said about 15 years ago. It’s the thing about a true tinnitus patient.

Doug Beck, AuD
Tinnitus impacts their thoughts and their emotions about 100% of the time. So it’s not just that you could say, Oh, just get used to it, everybody has it, that’s never going to work and that’s wrong. So there’s about three or 4 million people in the USA who have unrelenting tinnitus, and they are the tinnitus patients that most of us treat people who just every now and then notice tinnitus, that that’s not who we’re talking about. Same as, as audiologists, when we as audiologists, our areas of expertise where we are the ultimate authority is hearing is listening is vertigo, is other balance disorders is tinnitus, things like that, you know, the auditory system, which of course interacts intimately with the vestibular system. So tinnitus patients are rare. You know, everybody has to there’s 50 million people have it says one out of five, one out of six people in the USA has tinnitus. But it’s not it’s not so bothersome. There was a study that came out in 2011, maybe 2012 by the group, headed by this fellow named Dr. Bianchi. And he looked into Scandinavian, he sent out 20,000 questionnaires in Scandinavia and they have national health service. So it wasn’t a matter of price price has nothing to do with your health care is free. And so he sends out this questionnaire and he says, tell me about your tinnitus and what what do you think about what causes your channels? So that went up to 20,000 people? Well, 61% 11,000 of them responded. Now if you know anything about questionnaires, generally when you send out a questionnaire, you get three, four or 5% to get 8% Oh my gosh, you know, incredible. So we got 61% randomly assigned people responded. And this is what they said. They said that if you have a little bit of stress and a little bit of tinnitus, now you have a lot of tinnitus. So they thought that one of the main predisposition predisposing factors, somebody who would complain about tinnitus, that it was so bad that you know, it’s interrupting their life horribly was stress. And then of course the question comes up right, chicken or egg right, did they have stress and then as a result, did they manifest tinnitus? Or do they have tinnitus which causes them stress? You know, chicken in it. Now I can tell you what came first chicken or an egg. All chickens come from eggs. But all eggs don’t come from chicken. So what happened was the egg came first which Still tells us nothing about tinnitus. So there are many, you know, there’s a bazillion reasons why somebody could have tinnitus and we know about 80% of the time. People who have tinnitus also have hearing loss. So you asked about people with mild to moderate sensory nerve loss, which is the single most common type of hearing loss. In fact, age related hearing loss is mild to moderate sensory nerve loss. presbycusis is age related is mild to moderate sensory loss, noise induced hearing loss most often mild to moderate sense. So it’s very, very common. It’s the most common profile of anybody with significant hearing loss. But remember, I said there’s 50 million people that have tinnitus. Now the thing about 80% of them have hearing loss. But that means 20% don’t. And that means that there’s 10 million people with tinnitus, who have no hearing loss. So the question becomes, does hearing loss cause tinnitus? And the answer is no. Hearing loss is highly correlated with tinnitus. But it’s not cause and effect.

Doug Beck, AuD
It’s not like you have any further every patient with hearing loss does not complain of tinnitus. So one does not cause the other but they cohabitate your brain, right? They they’re often highly correlated. And in 2012, I think it was I wrote this paper, where I said, 80% of all patients with tinnitus have hearing loss and 80% of all patients with hearing loss have tinnitus. And that’s called the 8080 rule. And if you just Google that, you’ll see lots of very famous audiologist and other doctors who have said, it seems to be about right, maybe it’s 7030. Maybe it’s, you know, maybe it’s 8515. Maybe it’s 8585. But But you know, it’s close, and whose numbers used as a matter of who study you read, because all studies, all good scientific studies, you know, come out similarly, generally. And, but but it does depend on the population you’re studying. So they can vary a bit. And and if they’re wildly off, then that means probably the hypothesis is wrong, we need to rethink that before we test further, because we’re getting wildly different results in good random controlled trials. That means we’ve lost something we’re not quite as yet.

Ben Thompson, AuD
Thank you. Thank you, Doug. And there’s two things I want to bounce off of what you just said, First, let’s talk let’s, let’s talk about stress. And second, let’s talk about that counseling that education for someone who may be listening to this, who maybe found us online because they’re looking for help, whether that’s they haven’t actually sought help from a doctor yet, or the doctor they got help from seemed to belittle their problems or not have the knowledge or the resources to supply them with what they need to know. So how do you approach that appointment? You’re an audiologist. If you’re in that seat with someone who comes in, you don’t know much about their life, you don’t know much about their stress, but you know, they have tinnitus and it’s bothering them. How do you have that conversation?

Doug Beck, AuD
So there’s a lot of ways to approach it, and my preferred way is called PTM, progressive tinnitus management. If you were to Google, Tennessee, tinnitus management protocols, there’s at least 10 that are in the mainstream. The most popular are CBT cognitive behavioral therapy, tr T, tinnitus, retraining therapy, and progressive tinnitus management. So you start with a patient I I like to do something called the th II tinnitus handicap inventory because it’s able to qualitatively grieve the tinnitus. So we know what we’re talking about. Sometimes a patient will tell you, well, yeah, it keeps me up. Now limb is not a real problem. So I understand them that I need a number I need to, to give the patient one of the there’s seven or eight really, really good questionnaires. The standard is the tinnitus handicap inventory is not the best, but it’s the standard. So that’s 25 questions that the patient and I will talk about, I’ll ask the question, they’ll answer it. And then I’ll make sure that I understand their answer clearly. So we’ll have a good discussion about these 25 questions that allows me to quantify how bad their tinnitus is. And I could use a different tool. But again, that’s the standard. From there, I want to do things that will tell me how much it’s interrupting your life, you know, and we have lots of tools of this type that allow us when we’re working as a hearing doctor, rather than as a tinnitus doctor, we do the same thing you know, it’s not about your autograph, you know that autographs are the gold standard for hearing. But but that doesn’t tell us what your brain is doing with the sound that doesn’t tell you how to tell us how you understand speech to noise that doesn’t tell us the most common things we need to know. And with tinnitus, we could simply describe the tinnitus and almost always the patient can describe it for us. And there are certain tools where we can dial it in or let the patient or their men Rex is one of the one of our sister companies and they make a tool that the patient can actually dial in virtually any sound just pure tones, not just narrowband. So they can say it sounds kind of like this. And that’s really useful because that tells us the pitch, the loudness and the time timbre the quality of the sound because our goal is not necessarily to eradicate that sound, our goal is for the patient to be able to manage with that sound. So what happens is we’re trying to define what it is they’re hearing, we’re trying to see how much difficulty it’s causing. And then we have a lot of things we can do about it. Now before we go further, let me just clarify that every single patient, I believe, after 35 years as an audiologist, who has tinnitus should be seen by their physician, they don’t necessarily have to see an EMT physician, but they do have to see their GP or their internal medicine or family practice doctor, because there are medical diseases and there are surgical problems that that can create the sensation of tinnitus. So a couple of grounds. 97% of all tinnitus is what you’re talking about that is subjective where the patient perceives the sound, and it has no physical orientation. It doesn’t start with a physical thing. 3% of all tinnitus patients have objective tinnitus, and that means they physically have something causing it could be a Payton, Eustachian tube, it could it could be an acoustic neuroma, brain tumor, it could be disarticulation of the three little bones, the malleus, the incus, and Stapes. It could be a lot of things. So always step one, see your doctor, make sure that your doctor says, you know, you’re clear to see an audiologist and then do that. As an audiologist, I’m going to start with defining your tinnitus, I want to get a complete hearing test, not a screening, I want to complete a highly detailed hearing test that tells me a lot about what you’re perceiving.

Ben Thompson, AuD
Yeah, I just wanna I just want to echo what you’re saying how important that is, being a tinnitus therapist, I know when I see someone for the first time, if they’re coming in with all of this objective information, then we can recommend the treatment and the therapy with more confidence and better outcomes for them.

Doug Beck, AuD
Right. And you don’t want to proceed at all unless you know that the patient is medically cleared. Because, you know, one of the first things we do as audiologists one of our primary responsibilities is to refer to physicians, when we suspect there’s a medical or surgical issue here. And so let’s So that said, and I agree with you entirely, you know, we want to be able to evaluate the tinnitus put a number on it, so we know how bad it is. There are many people who are incredibly highly stressed, unable to sleep, unable to work, unable to concentrate, unable to hear because their tinnitus is so bothersome. Now the number one cure is well I shouldn’t say cure, there is no cure. The number one management technique for hearing loss for tinnitus with or without hearing loss is actually hearing it. And that may strike people as weird if they don’t have hearing us. But so let’s go back to the numbers. 325 million people in the USA is at 37 38 million people have hearing loss on an audiogram. There’s another 26 million people in the USA who have no hearing loss Illinois at all. However, they have hearing difficulty and they have speech and noise problems. In other words, the sound that they’re hearing, even though they’re hearing it normal loudness, their brain is unable to use it in the same way that other people can do it. They might have traumatic brain injury, a DD ADHD, auditory processing disorders, auditory neuropathy spectrum disorder, they may have mild cognitive impairment, they may have Alzheimers, they may have other neurocognitive disorders, they may have cochlear synaptic apathy, they may have hidden Nero. So all these things, you can have absolutely normal thresholds, and tremendous difficulty listening, attributing meaning to sound, the number one thing we do for those people, particularly children who have auditory processing disorders, we give them like an FM system, which is kind of a radio thing. But it’s it’s most often embedded in hearing aids. And what it does is it improves the signal to noise ratio. Now I know that’s complicated for most people signal to noise ratio is right now I’m speaking at maybe 70 decibels. So let me be here. And if I had a bunch of people behind me speaking at 68 db, so it’s only this little difference of two dB, most people wouldn’t be able to understand me, the noise would be too much. But it’s 70. If the background noise is like a 30. That’s a 40 decibels signal to noise ratio. And that’s very, very easy for just about everybody. So when people have hearing disorders, when they have listening disorders when they have hearing loss, the number one thing we try to do with hearing aids is we improve the signal to noise ratio. Now, of course, we need to make things louder, depending on how much hearing loss. But the goal isn’t just to make it louder. The goal is to make it clearer, which means it has to be substantially louder than the background noise now tinnitus functions. In 2014 2015, the British society of Audiology and the National Institute of Health in the United Kingdom asked this exact same question. He said, what do you do with people who have tinnitus that is unrelenting? So they’re seeking help, but they have no hearing loss? Would you? Would you fit them with hearing aids? And the answer of the expert panel, I think was 26. People said yes. Because it’s the easiest thing to do. It gives them It makes the background noise louder. So it D focuses the brain on the tinnitus, it helps 80% of the people because again, 80% of the people with tinnitus have hearing loss. So there’s they might have stress, depression or anxiety, secondary to having that hearing loss because they can’t communicate well. So what happens and we know this now from the Lancet study in 2017. But people who don’t hear well, socially isolate themselves, they don’t participate as actively in social events, like family like games, like going to restaurants, going to weddings, going to bars going to taverns, going to social events, going to book clubs, they don’t do that, because they can’t understand what’s going on around them. So they’re so socially isolated, which is very, very bad for your brain. So here’s a really interesting study, you can google this dementia, comma 2017, comma, the land set, the land set is the world’s authoritative, most authoritative medical journal comes out of the UK. And they said they were talking about dementia and hearing loss. And they said two thirds of your risk for dementia have nothing to do with hearing loss. It’s genetic. It’s based on your DNA or deoxyribonucleic acids. But one third of your dementia risk is due to nine factors, things like diabetes, things like drug abuse, alcohol, social isolation, hearing loss, smoking, less education, I don’t know how many I just mentioned, but those things, of all of those nine factors, a hearing loss was largest.

Ben Thompson, AuD
And that’s significant talking about dementia. Those nine factors, you can have some control over the other them.

Doug Beck, AuD
Right. That’s exactly the point. So when you have hearing loss, and you address it, you you know, we can’t say that fitting hearing loss will reduce dementia, we don’t know that. It’s trending in that direction. There are many scientific studies that say that when you address hearing loss in people who have hearing loss, that you you might delay the onset of dementia. And that’s not trivial. In the USA, if you go to the American Alzheimer’s Association website, you’ll see that by age 85, about 45 to 50% of Americans have Alzheimer’s. Now Alzheimer’s is only one of 200 different types of dementia. So you know, when you when you get up to 7580 8590, it’s not at all unusual to have dementia of some sort. So if you can protect yourself if you have hearing loss by wearing hearing aids, cheap and easy solution and it makes it easier for you to communicate and easier for you to socialize. Now that’s not a promise and nobody can promise that and don’t be Don’t be brought in when people say oh we’re gonna we’re gonna fit hearing aids protect your brain.

Doug Beck, AuD
Well, that may happen and that may not I have a brand new paper came out may 2020. It’s Journal of otolaryngology ENT research. And we talk about the most exciting cutting edge stuff that we know, you know, based on the peer reviewed literature, as far as hearing loss and cognition and amplification. So spoiler alert, what we know is that there are many studies that have shown that when you use amplification, the opportunity for success increases. But we don’t yet know who the best candidates are. And we bet them and we don’t know that, that we can promise everybody who gets hearing aids, it’s going to positively impact your brain. We know that.

Ben Thompson, AuD
Yeah, Doug, I want to bring up something for our listeners. And thanks, everyone who’s listening. Thanks for sticking with us. We have about 10 more minutes. And we’re gonna go deeper into this and some other topics. I think we Rob’s really important point. And we can use two analogies here. One is hearing loss. So if the problem is I can’t hear my family having difficulty hearing, then you would think a hearing aid only affects that problem. But because we have a global neurological system and a global brain hearing, that hearing improvement can improve other factors that relate to dementia and cognitive decline. Similarly, for our patients who are mainly here to work on their tinnitus, we know that same rule applies because you can’t direct because you listening out there cannot directly lower your tinnitus with a button with a switch. Right have to access it in indirect ways. And one of those indirect ways is to use a hearing device to have increased sound stimulation. Some other factors would be improving your stress and accessing the healthy parts of your nervous system, getting out of your head and relaxing into your body as well as working on your sleep. So what are your thoughts on that how indirectly indirectly you’re you’re improving what you want to improve, but it may not be so obvious to someone who doesn’t want to research.

Doug Beck, AuD
It’s a brilliant point, because remember what I said there’s three that really matter to me three treatment protocols CBT cognitive behavioral therapy, which works about 99% of the time, which is, you know, psychological based treatment. And so the question becomes, well, why wouldn’t you just send everybody there since it’s got a higher rate? Because in audiology, we say that progressive tinnitus management probably works about 90 95% of all patients CBT I mean, 99% why not send everybody for CBT because 80% of them have hearing loss. And if we don’t diagnosis and treat the hearing loss, we can do a psychological intervention that may reduce stress and may make them cohabitate better with their tinnitus and is probably going to work if they still have hearing loss and they’re still going to socially isolate because they still can’t understand. So So back to your point with when you fit people with amplification, right, you reduce the tinnitus, intrusiveness, you aid habituation you distract attention from tinnitus, and you do trigger neuroplastic changes. Now, in 2020, there are a number of papers one of the most famous is by Hannah Glick and Otto Sharma. And they looked at cross modal changes when you fit hearing aids to people. And they found that when hearing aids are expertly fitted, using things like pro mic measures, which is very, very important. And when they do speech and quiet and speech noise, you could absolutely change the way the brain functions with good amplification. And when we talk about eating habituation. So here’s a little bit of a crass analogy, but you know, I live in Texas, and I’m about so and so right now think about your underwear. virtually everybody listening can all of a sudden feel their underwear, right? But it’s non injurious, it’s non threatening, so you can blow it off, you habituate to it. habituation is how like right now, you know, my beard doesn’t itch because I’ve been letting it grow for a few weeks. But when I first started letting it grow, like itching like crazy, but I couldn’t get you into it so I’m not aware of it with tinnitus, tinnitus patients cannot habituate to their tinnitus. That’s why they are tinnitus patients tell him to get used to it is kind of useless because if they could they would have so when you’re using hearing aids, you help people habituate to aided sounds. And so it’s it as you were saying, you know, your brain is plastic, you have cortical neuroplasticity.

Ben Thompson, AuD
You talk about plasticity. Can you explain plasticity for someone who doesn’t understand that term? Because I know that’s a common question. What is neuro plasticity? Can you simplify that?

Doug Beck, AuD
Yeah, so neuroplasticity is the ability of your brain to change. And an easy way to think of that, if you and I, supposing you don’t speak French, and you and I take French lessons, right, within about five or 10 lessons, you’re starting to do numbers in French or doing common nouns in French, Spanish, or, you know, as your brain is, but you can learn it, you can absolutely change your brain, you can change the way musicians, I am a professional musician, I’ve been a musician for over 40 years. And and so musicians brains are extraordinarily plastic, they, they are able to listen to songs in different keys, and without an instrument in their hands. You know, they can tell you what the chord changes are, because they’re used to it because they’ve trained their brains to do that, again, chicken and egg. Do musicians become musicians because they have a higher aptitude for music? Or do they become Do they like music so much, they start developing their brains, and then their brains become very different. So that’s true. musicians, brains under an fMRI, listening to music look very different. So neuroplastic changes are how your brain adapts. And it changes anatomically. And physically, in response to stimulate your brain, you only have five points of stimulation or your brain, right, you have five sensory inputs, you have, you know, your eyes, your ears, your nose, your tongue and touch. That’s it. So your brain is a deep black box hidden in your cortex in your brain in your skull. And it has all this input from different senses, that has to make sense of, and your brain never stops being able to do that. We have people who are at 8590, who have been treated for tinnitus, very, very successfully, probably 90% of them, and their brains can change and they can adapt and they can habituate. It’s not easy, takes effort takes time. And you have to work with somebody, the chances of you just reading about this and doing it yourself is pretty low. It’s a guided thing that you do with maybe an audiologist, maybe a psychologist, maybe a social worker, but it doesn’t matter who you’re dealing with there. There. There was a study of 500 patients out of the UK, this is a 2016 where they looked at the level of knowledge of the person who was working with you in progressive tinnitus management or cognitive behavioral therapy. And the typical treatment in the UK, is they would have a social worker doing CBT cognitive behavioral therapy, and there’s nothing more on social workers. They’re brilliant. They’re nice. They’re kind people But a PhD in clinical psychology has more knowledge about this stuff. It’s like, I hope this isn’t politically incorrect. But I’m a Doctor of Audiology. I have a lot of knowledge about audiology, it’s not a cut on hearing aid dispensers, some hearing aid dispensers, you know an awful lot about hearing aids, absolutely. But all the books are written 99% of them by audiologists, all the studies are done by audiologist. And we teach most of those classes because we have more formal education, more knowledge about these things. It’s like a doctor versus a, you know, a nurse, I mean, most RNs have a bachelor’s or perhaps a Master’s, there are doctorates in nursing, so they’re going to have even more knowledge than a nurse. So what they did in this study, they look at social workers, using customer treatment, versus PhD clinical audiologist doing the same thing, cognitive behavioral therapy for tinnitus patients. And they found that it was cheaper when you’re out to just go straight to the clinical psychologist, because instead of maybe 10 visits, you took six, instead of the patient scoring better, they scored a lot better in their ability to coexist with their tinnitus. So yes, it does matter who you see and attended a specialist is probably going to be much more familiar with the problem than a regular audiologist. All audiologists deal with tennis all the time. But most of us don’t make it our area of expertise. So we have good working knowledge, we can help some people but we also know you know, if somebody is particularly stressed, and somebody is, you know, losing sleep losing maybe their job or their life or you know, the things that are most important to them because their tinnitus is unrelenting, we need to refer to somebody more knowledgeable and quite often as somebody who specializes in tinnitus. Now that could be an audiologist, it could be a clinical psychologist, but clinical psychologists do a bazillion other things. So it’s not just any clinical psychologist, if I’m going to refer to a clinical psychologist for tinnitus, which I have certainly done in my life, it’s got to be somebody who treats tinnitus, you know, and it’s got to be somebody who is up to speed on CBT, because there are habituation therapies. And that might work to give enough, you know, depending on the situation, but I generally look for psychologists in my area, who specialize in tinnitus, and who are familiar with cognitive behavioral therapy, because I know that’s going to be a homerun 99 times out there, you know, there’s lots of other psychological interventions, and many of them work fine. But, you know, I have to be assured that when I’m referring a patient, that they’re going to somebody competent, somebody who’s doing something that I’ve read, and I’m familiar with, and that I know it’s a success, I, I never refer patients just, you know, willy nilly. And I think it’s important because ultimately, if you have a great audiologist or great podiatrist or great chiropractor, great whatever speech language pathologist, they want to, you know, it’s continuity of care, I don’t want to just send you back to your commercial insurance company to find somebody, I’d like to send you to somebody that I really, really talented and competent.

Ben Thompson, AuD
Yeah. Thanks so much, Doug. And it’s been great so far on this, this live interview here. So let me just recap what we’ve covered. so far. We talked a bit about your own personal audiology journey. And then we got into the specifics about the current research and different models to base Tinnitus Treatment off of we took a deep dive into progressive tinnitus management, which I know a few years ago, you recommended as the most evidence based robust protocol. Do you would you still say yes to that?

Doug Beck, AuD
Yeah, it still is. I mean, there’s nothing that’s that’s taking the place of that.

Ben Thompson, AuD
Okay. So I want to I want to end our interview with sort of rapid lightning round, just some quick questions, some simple quick questions, keep your keep your answers to a sentence or two. Have you been following Oto 313? And what’s your what’s your update on that for any listener? Who has tinnitus? who’s looking for the research cure?

Doug Beck, AuD
Hair cell regeneration has been brand new for about 40 years now. I mean, when I was sitting where you’re sitting hair cell regeneration was all the buzz it didn’t work out. I that’s not to say it won’t work out in the future. Now, here’s a couple of things to know about hair cells, mostly, you know, you have outer hair cells in your hair cells, they have nothing to do with these types of pairs. There are neurons but but regardless, even if you could regenerate them, and I hate to tell you, the birds regenerate them every day, lots of animals regenerate hair cells, humans don’t. The thing about that is once they’re regenerated, then they have to somehow be tied into your central nervous system. Yeah, so simply and it’s not simple at all, but regenerating hair cells. I hope we can do that sometime. That would be awesome. I know they’re a positive word, particularly when you’re looking at animal studies. Because there are many animals. Yeah. But this, this is a problem because some of us misinterpret this as Oh, we’ll do it in humans now that we’re doing an animal. Well, the animals had a leg up on that stuff. Then the other thing is, of course, once you have a hair cell, it doesn’t exist in isolation. It has to be tied to an auditory nerve of which there’s like 20,000 fibers on each auditory nerve. How are you going to connect those and then if you could do that, then you have to have a chemical synapse that would fire from the outer hair cells or the inner hair cells to the auditory nerve, which is a chain of bioelectric reactions that has to happen in a coordinated correct fashion, to make sense. So, so without knowing anything about that study, I can tell you that, although I’m hopeful that one day we will do this, I don’t think in the near future, I could be wrong.

Ben Thompson, AuD
Thank you for that. It’s a complex process. And I think the intention for people who are asking these questions in the online tennis communities that I’m a part of, is looking looking for help looking for a fix looking for a cure. And as we talked about in this discussion, oftentimes, that can be a false hope it can be leading you away from what you can do right now. So in terms of managing stress, I know what you do to manage your own stress is is not what’s gonna work for everyone. And I know that you’re not a stress specialist. But I want to ask you, when you feel stressed, how do you manage your stress?

Doug Beck, AuD
Well, they’re all musician. So when I feel particularly stressed, you know, I’ll tell the piano or bang up some drums or I’ll play guitar or something. But stress management is critically important because again, that study by big and colleagues is the largest study I’ve ever seen on tinnitus. And 12,166. People said, stress makes the tinnitus worse. So I think there’s probably a good connection between stress and the manifestation of unrelenting tinnitus. There are many things that have been shown to work, yoga works for some people, not all, there are certainly examples of acupuncture. Now, acupuncture is very interesting, because it’s 1000s of years old. And it’s very effective on pain relief. But everybody, it doesn’t work, you know, it works for some people, tinnitus, relaxation therapy, and there are some people who meditate and you know, these things are not trivial these things. There’s science behind all of these, that they work for some people. But again, as I was saying earlier, with hearing aids, we don’t know which candidate we don’t know how to pick the right person for the right solution. So sometimes the audiologist is gonna have to try a couple of things. Because it’s like an audiogram is when you think about hearing loss, you’d have 10 patients with the exact same urinals. you fit in with 10 different hearing aids for 10 different reasons. And it’s the same with tenants, you know, you could, you could describe your tinnitus is 5200 hertz, and it could be a sensation level of 20 decibels. Great. But if I attend people with that exact same percept, they’re probably going to need 10 different solutions. Some of them might get by with just a bedside mask or, you know, so when they’re trying to go to sleep at night, others may enroll in, in a Zen class, or they may, they may exercise and the more they exercise, they may find that that’s useful. There certainly have been reports that when people do swimming when they do walking and running when they walk their dog, for many, many people, it’s incredibly relaxing. Now, if you have a really nasty Doberman Pinscher, and you’re constantly pulling up, that’s probably not gonna reduce your stress. But if you have, you know, like a regular dog that you like, hanging out with some people find, you know, pet therapy works. So you got to try. I mean, there’s no, it’s exactly what you said, Ben, there’s no one to argue Moeller wrote this in 2011, he said, you know, trying to cure tinnitus with one treatment is like trying to cure cancer or pain with one treatment. And the problem is the cancer and pain are not one thing. There are many, many, many things and it is a noble goal to cure all cancer with this entry in order all pain with one treatment. It’s just not ever going to happen. Because everybody who perceives pain and some people, some people describe tinnitus as pain, right? So if you Oh, and that’s another reference, by the way, pain management. If you have no tinnitus experts in your area, sometimes you’ll find somebody in a chronic pain clinic who knows somebody about cognitive behavioral therapy and they know about that.

Ben Thompson, AuD
Thank you, Doug. Thank you, Doug. We definitely covered a lot here and bringing it back to managing stress how that could be the easiest, fastest, cheapest way for you who’s listening to actually improve the tinnitus. And as the research has shown, when the stress was really improved for some percentage of those who have tinnitus, the actual loudness can also improve indirectly. So absolutely. So look into that everyone who’s listening and I just want to give a big thank you to Doug Beck, who’s a Doctor of Audiology and the current vice president of academic Sciences at oticon. He has an extensive list of publications as you heard from today’s discussion about audiology research, tinnitus, and more. And Doug As a ritual, something fun that we do. At the end of each of these podcast episodes, we ask you, what is your favorite sound? Now for some people, this might be the sound of their, their child crying or the sound of the river in their local town. What would you say right now is your favorite sound?

Doug Beck, AuD
Wow, you know, nobody’s ever asked me that before. Um, probably, rain on the roof.

Ben Thompson, AuD
Rain on the roof. Does that bring back any specific memories?

Doug Beck, AuD
No, but I think it’s very soothing. There was a guy named Charles Penske and probably saying his name or he did all this research on what sounds people like because when you think about tinnitus, and you think about masking sounds, kill that word masking. We shouldn’t say that I was just corrected recently by Dr. Tara zog and she said, be better to talk about soothing sounds and I tried as soon as he said that, I got it. I agree. So for soothing sounds, the number one sound is actually like water, whether it’s waves whether it’s a babbling brook, whether it’s rain on the roof, and think about it, because when you have soothing sounds like through your Bluetooth connection to your phone, you know, you want something that’s pleasant, you want something that is non a versiv. And I think most people dial up rain on the roof, babbling Brooks, Roshan sounds.

Ben Thompson, AuD
Thanks so much, Doug. You can find him is that DouglasLBeck.com.

Doug Beck, AuD
And for those of you who are musically oriented at the bottom, I have like 10 or 15 of my songs, which are mine. They’re all you know, hack jobs that I did in my basement.

Ben Thompson, AuD
Doug, thanks for coming in live from Texas. And it’s been great to get to know you personally. And thank you for sharing your wisdom and your years of experience with the pure attendees community. So anyone who’s listening, make sure you leave a comment here about what you learned. And you can ask me any questions and I’ll try to answer them. And we’ll see you soon for the next episode.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson is an audiologist in California and founder of Pure Tinnitus. Dr. Thompson has a comprehensive knowledge of tinnitus management. He completed his residency at University of California at San Francisco (UCSF) and is a past board member of the California Academy of Audiology. Via telehealth, Dr. Thompson provides services to patients with hearing loss and tinnitus.

Comments

You may also like